Accreditation Program Manager

FLSA Status: Exempt
Department: Quality Improvement
Reports To: Manager, Process Improvement

GENERAL DESCRIPTION OF POSITION

The Accreditation Program Manager is responsible for developing work plans, gap analyses, conducting internal audits, reviewing documentation for compliance, and facilitating stakeholder collaboration for all program planning and work stream facilitation in support of National Committee for Quality Assurance (NCQA) accreditation survey readiness. The Accreditation Program Manager is responsible for working collaboratively and cross-functionally with internal and external stakeholders, including consultants, auditors and surveyors to create efficiencies and improvements to meet accreditation standards at Santa Clara Family Health Plan (SCFHP). In addition, the Accreditation Program Manager is responsible for projects assigned, including providing ongoing support to organizational initiatives by leading the analysis and implementation of accreditation related medium to large scale projects and efforts. 

ESSENTIAL DUTIES AND RESPONSIBILITIES

To perform this job successfully, an individual must be able to satisfactorily perform each essential duty listed below.

1. Lead and organize all accreditation activities to achieve and maintain plan accreditation in Medicare and Medi-Cal lines of business including creating, monitoring and executing project work plans and deliverables with business units.

2. Serve as accreditation liaison, working collaboratively and cross-functionally with internal and external stakeholders to ensure NCQA compliance, including delegates.

3. Serve as the primary point of contact with NCQA for policy clarification questions, administrative maintenance, payment of invoices, survey preparation and any other communication.

4. Lead and facilitate medium to large scale quality and process improvement projects by providing direction for project framing, organization, business case analysis, implementation, and outcome/success measurement related to accreditation requirements.

5. Conduct routine internal audits to assess business unit readiness for document review and onsite file review. Work alongside project managers to facilitate workgroups and track standards deliverables progress.

6. Drive adoption of continuous improvement across the organization by supporting and coordinating business change initiatives and activities associated with process improvements and system changes to ensure smooth transitions for stakeholders related to accreditation requirements. Partner with Compliance department to streamline internal and external audit and oversight requirements of accreditation.

7. Define organization standards for consistent approach to accreditation work and coach business partners on application of the standards

8. Develop and maintain all appropriate accreditation project documentation, including timelines, project scope, decision logs, work plans and internal website presence. This includes development of process documents including, policies/procedures, process maps, workflows, desktop procedures, and deliverable templates.

9. Maintain accreditation program documentation for annual committee review schedules and workgroup membership. Where revisions are needed, work directly with business units to adjust.

10. Identify, research, and resolve accreditation project issues and escalate critical issues, problems, and delays to management and executive leadership, as needed.

11. Conduct an annual review of revisions to accreditation standards and ongoing evaluation and interpretation of quality standards and accreditation standards to ensure compliance, including impact to existing delegation agreements.

12. Develop and maintain training materials for new and existing staff to help interpret and understand requirements and the impact of changes.

13. Develop and distribute timely accreditation project communications and status updates.

14. Maintain a thorough knowledge of NCQA requirements to ensure compliance and understand the impact on various areas of operations.

15. Work collaboratively with peers, executives and front line staff to drive improvements in existing operations, and develop/implement initiatives to improve efficiency and effectiveness.    

16. Perform other related duties as required or assigned.

REQUIREMENTS – Required (R)   Desired (D)

The requirements listed below are representative of the knowledge, skill, and/or ability required or desired.

1. Bachelor’s Degree in Management, Business, Healthcare, or a related field, or equivalent experience. (R)

2. Minimum three years of experience in health and/or managed care with res